{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" HTENNEKNWORB R ","gend":0,"add":"LRIHW 1055DAOR YAWA","city":"VIRGINIA BEACH","state":"VA","zip":"23462-9998","dob":"1968-08-15","age":"","mstatus":"","insh":"2760210*94","cliId":"","pno":"7475762707","cno":"","email":"","ename":"","eno":"","pphy":"BRADLEY, CONNIE S NP","ppno":7573952500,"pcpadd":"1024 FIRST COLONIAL RD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":"23454-9998","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - First Colonial","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z94.1","B25.9","I51.7","Z12.11","R05.9","R09.89","R11.0","R51.9","R53.83","R52.","D23.61","L85.8","Z20.822","C44.712","Z09.","M25.562","M25.462","E55.9","Z12.5","E78.2","E09.9","Z03.818","Z51.81","I10.","R10.9","R07.9","T14.90XA","M54.2","S09.90XA","M25.512","Z48.21","I82.531","I87.2","R20.0","R20.2","R07.89","L57.0","M79.604","J01.90","N18.32","Z48.817","J11.1","B99.9","K44.9","S20.212A","S22.010A","S30.811A","I50.9","Z88.6","Z88.5","Z88.2","Z88.8","I82.401","M22.42","M17.12","D48.5","D84.821","Z79.899","E78.5","Z23.","U07.1","J98.8","R10.84","R11.2","R19.7","Z86.718","Z86.79","I12.0","N18.30","F41.9","Z79.890","V89.2XXA","L30.9","C44.329","C44.41","L91.0","E03.8","N18.31","R73.01"],"date":["2023-07-03","2021-03-17","2022-09-01","2021-08-30","2021-12-15","2021-12-15","2021-12-15","2021-12-15","2021-12-15","2021-12-15","2022-04-21","2022-04-21","2022-05-09","2022-09-08","2022-09-01","2023-02-22","2023-02-22","2023-07-03","2021-08-19","2023-07-03","2021-08-19","2022-02-21","2022-09-01","2023-07-03","2022-04-06","2022-04-06","2022-04-06","2022-04-06","2022-04-06","2022-04-06","2022-07-18","2022-06-13","2022-06-13","2022-07-18","2022-07-18","2022-07-18","2022-11-01","2021-05-11","2021-10-26","2022-05-16","2022-09-14","2022-11-04","2021-02-11","2021-02-11","2022-04-06","2022-04-06","2022-04-06","2022-04-06","2022-04-06","2022-04-06","2022-04-06","2022-04-06","2022-06-13","2023-03-23","2023-03-23","2021-02-26","2021-06-08","2021-08-11","2021-06-08","2022-06-20","2021-02-11","2021-02-11","2021-02-11","2023-07-03","2021-02-11","2021-08-11","2021-02-11","2021-08-11","2021-08-11","2021-08-11","2021-08-11","2022-04-14","2022-11-01","2023-05-16","2023-05-02","2023-07-07","2023-07-03","2023-07-03","2023-07-03"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","68084045001","TACROLIMUS","1 MG","360","Select","Select",""],["","68645055154","LISINOPRIL","TAB 5MG","30","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","00093550456","OLANZA\/FLUOX","CAP 6-25MG","180","Select","Select",""],["","00054016629","MYCOPHENOLAT","TAB 500MG","180","Select","Select",""],["","72205000530","ROSUVASTATIN","TAB 40MG","90","Select","Select",""],["","47781064390","LEVOTHYROXIN","TAB 50MCG","90","Select","Select",""],["","00003089421","ELIQUIS","TAB 5MG","60","Select","Select",""],["","43547040211","FUROSEMIDE","TAB 40MG","30","Select","Select",""],["","31722059590","FENOFIBRATE","48 MG","90","Select","Select",""],["","55111028130","LEVOFLOXACIN","TAB 750MG","10","Select","Select",""],["","00093005805","TRAMADOL","TAB 50MG","36","Select","Select",""],["","00143924920","AMOX\/K","TAB 875-125","14","Select","Select",""],["","00456315467","AEROCHAMBER","MIS PLUS","1","Select","Select",""],["","59310058020","PROAIR","AER ","1","Select","Select",""],["","00143928501","AMOXICILLIN","TAB 875MG","20","Select","Select",""],["","69543025216","VIRTUSSIN","SOL 100-10\/5","120","Select","Select",""],["","70700015010","OMEPRAZOLE","20 MG","30","Select","Select",""],["","69452014320","BENZONATATE","CAP 100MG","50","Select","Select",""],["","66993058497","FLUTIC\/SALME","AER 100\/50","60","Select","Select",""],["","00054004641","IPRATROPIUM","SPR 0.0006","15","Select","Select",""],["","67877019705","AMLODIPINE","TAB 2.5MG","90","Select","Select",""],["","65862084003","MOXIFLOXACIN","SOL HCL 0.5%","3","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","00406012301","HYDROCO\/APAP","TAB 5-325MG","10","Select","Select",""],["","50111078751","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","59746017310","PREDNISONE","TAB 10MG","5","Select","Select",""],["","72305005030","EUTHYROX","TAB 50MCG","90","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","12","Select","Select",""],["","42806054701","VITAMIN D CAP","1.25MG","4","Select","Select",""],["","42806054701","VITAMIN D","2 1250 MCG","4","Select","Select",""],["","67877019705","AMLODIPINE BESYLATE","2.5 MG","90","Select","Select",""],["","00093550456","OLANZA\/FLUOX CAP","6-25MG","60","Select","Select",""],["","70377000911","ROSUVASTATIN CALCIUM","40 MG","90","Select","Select",""],["","16729004201","TACROLIMUS CAP","1MG","360","Select","Select",""],["","72205000530","ROSUVASTATIN TAB","40MG","90","Select","Select",""],["","31722059590","FENOFIBRATE TAB","48MG","90","Select","Select",""],["","72305005030","EUTHYROX TAB","50MCG","90","Select","Select",""],["","16729044815","LEVOTHYROXIN TAB","50MCG","90","Select","Select",""],["","00054016629","MYCOPHENOLAT TAB","500MG","180","Select","Select",""],["","59746017310","PREDNISONE TAB","10MG","21","Select","Select",""],["","67877019705","AMLODIPINE TAB","2.5MG","90","Select","Select",""],["","57664037708","TRAMADOL HCL TAB","50MG","3","Select","Select",""],["","29300041519","CYCLOBENZAPR TAB","10MG","20","Select","Select",""],["","50111078710","AZITHROMYCIN TAB","250MG","6","Select","Select",""],["","00093405953","CEFADROXIL TAB","1GM","10","Select","Select",""],["","31722063231","OSELTAMIVIR CAP","75MG","10","Select","Select",""],["","00093101042","MUPIROCIN OIN","2%","22","Select","Select",""],["","00054016629","MYCOPHENOLATE MOFETIL","500 MG","60","Select","Select",""],["","16729044815","LEVOTHYROXINE SODIUM","50 MCG","90","Select","Select",""],["","00093550456","OLANZAPINE-FLUOXETINE HCL","6MG-25MG","180","Select","Select",""],["","68462015713","ONDANSETRON ODT","4 MG","30","Select","Select",""],["","49035056314","ASPIRIN EC","81 MG","90","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":"","a13":""}]}]}